Most men prefer informed decision-making for PCa

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Participants in an outreach event for prostate cancer screening preferred education about prostate cancer prior to undergoing screening, and thought the use of an informed decision-making model was beneficial, researchers reported at the Genitourinary Cancers Symposium in Orlando, FL.

According to first author Puneet Dhillon, DO, prostate cancer screening is a controversial topic and the 2012 U.S. Preventive Services Task Force guidelines do not support prostate cancer screening. However, prostate cancer is the most common cancer in American men, except for skin cancer, and the second leading cause of cancer-related death in men. (At press time, the USPSTF released an updated draft recommendation supporting individualized decision-making in men ages 55-69 years.)

Dr. DhillonThe incidence and mortality from prostate cancer is higher in African-American men compared to that in Caucasian men, and African-American men are often diagnosed at a more advanced disease stage and have a poorer 5-year survival rate. This puts them in a higher risk category for being diagnosed with prostate cancer. Health-education programs and culturally appropriate educational outreach efforts, especially targeted for high-risk groups, are needed to reduce these disparities,” said Dr. Dhillon, hematology/oncology fellow at Providence-Providence Park Hospital, Southfield, MI, who worked on the study with Samir Abraksia, MD, of Cleveland Clinic, and co-authors.

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The process of using informed decision-making is included in the guidelines of most organizations including the AUA, the European Association of Urology, and the American College of Preventive Medicine.

“Clinical investigation has found that physicians find it difficult to provide comprehensive, unbiased education about screening to patients,” Dr. Dhillon told Urology Times. “Empowering men to participate in decision-making in the face of uncertainty about prostate screening represents a major challenge.”

With this study, Dr. Dhillon and co-authors wanted to examine whether informed decision-making guidelines in a large high-risk group setting can improve knowledge on prostate cancer and screening decisions, and whether these programs ultimately benefit patients.

The intervention included 106 participants in a 1-day outreach event. Participants were exposed to a 20-minute PowerPoint presentation that was scripted to facilitate consistency and minimize bias affecting screening decision, and was created according to information and guidelines from the American Cancer Society. Patients were given a 15-question pre- and post-test and were offered screening using PSA and digital rectal exam (DRE).

Next: Most men favor education program

Most men favor education program

“Most participants favored informed decision making and education before being given the choice to be screened or not,” Dr. Dhillon said.

Seventy-five percent of participants found the intervention to be beneficial in making an informed decision about prostate cancer screening, including that the program was “very helpful” on a 5-point Likert scale. In addition, 75% of participants showed improvement in prostate cancer knowledge in the post- compared with the pre-test (p<.001).

After participating in the informed decision-making intervention, 86% of participants favored undergoing screening; of those who favored screening, 92% were African-American. Only 18% of participants said they would have preferred undergoing screening without the informed decision-making process.

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There were 14 participants with abnormal findings; 13 with abnormal PSA, five with abnormal DRE, and four with abnormal PSA and DRE.

According to Dr. Dhillon, these results demonstrate that “creating a model in which guidelines-based prostate cancer screening can be effectively and practically implemented in high-risk communities would empower men to actively be a part of this process.”

The authors are currently working to create a model that is effective in reaching high-risk populations for prostate cancer in larger volumes.

Dr. Dhillon has received travel, accommodations, and expenses from Genentech. Several study co-authors have a financial or other relationship with pharmaceutical companies.